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How We Appeal Your Case – Long Term Disability

Posted on: February 4 2014 / Written by: Dr. David Anaise

1. Demanding documents from the Insurance Company. We write the insurer demanding a copy of: the plan; the policy; the SPD; the claim file; all documents relied on by the insurer in denying the claim; any internal guidelines used by the insurer; the reports of all medical and vocational reviewers; audio or videotapes of the claimant; and notes of any telephone conversations.

2. Demanding Specific Reasons for Denial. By law the insurer is obligated to provide specific reasons for their denial. We write the insurer demanding that they provide us with a more specific description of the reasons for denial. Often the initial denial letter only states that there was insufficient objective evidence in support of your claim.

3. Gathering Records. We write your doctors requesting copies of all of your medical records. Often the insurer does not request your doctor’s treatment notes prior to their denial. These notes may corroborate your symptoms. It is important that a complete set of your medical records be obtained.

4. Additional Testing. Often there has been insufficient medical testing done to support your claim. In such a case, we help you obtain the proper tests either with your treating physician or we refer you out to a medical specialist. For instance, individuals with Chronic Fatigue Syndrome and fibromyalgia do not have ” objective testing ” of their disease. However, special function neuropsychological testing may show cognitive deficits, and testing by a physiotherapist may detect functional impairment preventing physical activities. We refer such clients out in order to obtain objective proof of such deficits. We work with a network of physicians, psychologists and physical therapist who treat and test our claimants and provide written reports.

5. Medical Reports. We procure opinion letters from your treating physicians explaining in detail why you are disabled. We also send your doctors customized questionnaires so that your doctor can provide very specific opinions about your inability to work. We also help your doctors address the concerns raised by the insurer in its denial letter. To be successful in the appeal process, every concern raised by the insurer must be addressed.

6. Scientific Research. I always conduct independent and in depth research of scientific articles and journals to help provide additional support for your condition. My expertise in medical research often sways the insurer to grant your claim

7. Once all of this information and evidence is gathered, we prepare a comprehensive appeal letter arguing why you are totally disabled and attacking all of the reasons for denial mentioned by the insurer. Although the appeal is formatted in the form of a letter, it is in every sense of the word a legal brief, complete with case cites, legal argument, and citations to the medical evidence.